Abstract
Anemia often coincides with depression and impaired quality of life (QoL) in cancer patients. Sustained immune activation can lead to the development of anemia. Furthermore, it also may go along with changes in tryptophan and phenylalanine metabolism. The aim of our pilot study was to study the relationship between anemia, immune-mediated changes in amino acid metabolism, and the QoL and mood of cancer patients. Questionnaires to measure QoL and depression were completed by 152 patients with solid tumors. Hemoglobin, parameters of immune activation as well as tryptophan and phenylalanine metabolism were determined in the patients’ sera. Anemic patients (51.7%) presented with higher inflammatory markers, and a higher tryptophan breakdown with lower tryptophan concentrations. They reported an impaired QoL and had higher depression scores. Patients with an impaired QoL (65.8%) also suffered from more fatigue and impaired physical, emotional, and social functioning. They, furthermore, presented with higher concentrations of inflammatory markers (C-reactive protein (CRP) and neopterin) as well as higher tryptophan degradation (in men) and higher phenylalanine concentrations (in women). Sixty-one patients (40.1%) had (mostly mild) depression. In these patients, a higher degree of Th1 immune activation was found. The results of our study suggest that cancer-related anemia goes along with an impaired QoL, which is also associated with immune-mediated disturbances of tryptophan and phenylalanine metabolism.
Highlights
Anemia is a comorbidity frequently encountered in patients suffering from malignant disease [1]
Anemic patients presented with significantly higher C-reactive protein (CRP) (0.90 mg/dL vs. 0.26 mg/dL, p < 0.001, Figure 1a) and neopterin concentrations (9.5 nmol/L vs. 7.4 nmol/L, p < 0.001, Figure 1b) as compared to non-anemic patients
Hemoglobin concentrations were correlated with CRP and neopterin concentrations
Summary
Anemia is a comorbidity frequently encountered in patients suffering from malignant disease [1] It is a condition characterized by fatigue, weakness, shortness of breath, or dizziness. All these symptoms impair the quality of life (QoL) of cancer patients significantly. Comorbid depression goes along with increased functional and emotional impairment and reduced optimism regarding the effectiveness of the medical treatment [6,7]. It is often not recognized and, not treated [8,9]. Depression and a decreased QoL have earlier been associated with decreased hemoglobin concentrations and increased levels of inflammatory markers [2]
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